Outline

Introduction: Blood transfusion has been characterised as a negative predictive factor for graft and patient survival in liver transplantation. Pancreas retransplantation is sometimes technically challenging due to retroperitoneal adhesions and iliac arteries compromised by arteriosclerosis, and can be related to increased transfusion requirements. This retrospective study evaluates the long-term results of perioperative blood transfusions on allograft survival after pancreas retransplantation.

Material and methods: Between 1994 and 2005, 31 consecutive patients received pancreas retransplantation. Patients were retrospectively divided in two groups: One group included patients receiving <4 erythrocyte concentrates (ECs) perioperatively (n=18), the other patients receiving ≥4 ECs (n=13). Daily blood sampling was performed during 5 postoperative days. Groups were compared in terms of demographic parameters, postoperative laboratory changes, and graft survival.

Results: Demographic and preoperative laboratory parameters did not discriminate between groups. There was a tendency towards reduced release of lipase in patients receiving ≥4 ECs. Hemoglobin levels, aPTT and INRs were not statistically different between groups. From 18 patients receiving less ≤4 ECs, n=7 (33%) could be managed without perioperative ECs whereas the mean number of ECs applied was 1.3Â±1.2. Hemoglobin levels remained stable about 10g/dl in both groups over 5d. Graft survival was significantly reduced in the ECs ≥4 group with a median survival time of 479.3d versus 915.8d in the ECs <4 group. The reduction in graft survival in patients receiving ≥4 ECs was significant.

Conclusion: Increased necessity of perioperative blood transfusion is related to decreased graft survival in pancreas retransplantation. It is difficult to analyse whether increased transfusion requirements reflect a higher rate of bleeding in high-risk patients, or whether EC transfusion directly interferes with graft survival. Potential risks include transfusion-induced sepsis, immunologic pathways (soluble HLA’s) and transfusion-related acute lung injury. Therefore, a more restricted use of perioperative blood transfusions may be advocated as well as the use of autologous blood transfusion